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AF - 47109�.. , � � � Villa e of Fridley, Minn. _ g BUILDING PERMIT �°• 18 5 9 Date: . . . . . . . . . . . . . . . � . .7. .'. . :��. . . . . . . Owner . . . . . . . . . . . . . . .. . . . . . .. . . . . . . . .. . .. . . . . Builder . � . . . . s�9.�'.�'�:-G���57���:'r: .. . . 4/?Z ��/� Address...................................... Address ............................................. L CAT(ON O� j BUILDING 1�To. . . !4. .�. .%. . . Street . . . . . . . . . . . . . . . . . . Y. . .. :CG�Gf/ . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . . . . Lot . . . . . /. . . . . . . . Block . . . . . .?. . . . . . . . . . Addition or Sub-Division . �a7l��n.t� . . . . . . . . . . . . . . .'�scC,y^ d � Corner Lot ........... Inside Lot ........... Setback .�.�? ... Sideyard ...� � .................... DESCRIPTION OF BUILDING To be lised a • , . � . . . . . . . . . . Front . �.�. . Depth !2 � :� Heigh�� s . . . Sq. Ft. . . . . . . . . Cu. Ft. . . . . . . . . ..................... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........ Type of Construction . f .�.'. . . . . . . Est. Cost . /. , , `3 D O a To be Completed . . . . . . . . . . . . . . . . . . Tn consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the village of Fridley. ..................................................... � /� Tn consideration of the payment of a fee of $. /. .�.2.'. . . . . , permit is hereby granted to . X+.'� . . . . . . . . ��-�' �%��.- Li��� ......................... to construct the building or addition as described above. This permit is granted upon the express conditiun that the person to whom it is granted and his agents, employees and worlunen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the village limits and this permit may � revoked at any time upon violation of any of tne provisions of said ordinances. . . . . . �. `� . . . . �i!.C��� . . . . . . Buildin Inspector . �- g NOTICE: This permit does not cover the construction, installa,tion or alteration for wiring, plumbing, gas heating, sewer or water. 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W. �F� � N � �` 04 N w U O E � � s � a p � ro a � � u v e N xx �i � a ..+', E �O ro N W ro yrt.� a +p� �'a a S F U F � U N � ro G a C1 � H � iT 0 a � N O � s� N a �1 ti. w M t0 � o �.�i A� w � N U � � c i � w � c d � 'O n d L C O c 0 >+: �' � ; � U ' � Z w ► G . � �,� �+ r,� �i N i [q E � iY � � i � �° �. � r" a� „� � r-+ v � � � �j �n vQ�� � r-+ 11') � ''7 C � � +-� �� XZ o p �m� r- V J � � O u' " � � n: °n �� a �o � n � .� O 0 � � N H N H � W a C7 F CW7 �a x a� U � � O E-� [� E W� �,, o � �� H f!] �a � 7 � .� 3 ro „ T Q� 3+ 'd O '� � N a+ c •.� �� C v �+ .-`°� c � •.� a, �°, A ro a� O � C bW U C N � H tn e �0 a�+ � LL C C S" � a� a s" « • City of Fridley, Mi.nn. BUILDING �PERMIT nate: sT.�ne �„ , 19� �.: James O�Donnell ��r Reco Construction �� � s�r N� '7854 pa� _ 63� Helene Placs N. E. p�� 1311 South .�t� St�eet �y►t.b�ti, �?'. , . LOCATION OF BUILDING Na b31 g� Hele�e Place N. L. ____..._..... Part o� Lot Lot �...—__ BIock 7 _..._._ Additiaa or Sub-Divi�t� .��� �dd. Coraer Lot _ Inside Lot — Setback _._.._..._...._...._�_ Sideyard 3ewer Ele�vatian �.r Foundatio� IIevati� To be Used as: Frcnt �`t+�t ?j►pe oi Ca�strucl3on DESCRIPTlON OF BUILDING DePth Height ....__.._._.. Sq. F'� Cu. Ft Depth Height _.___—.. Sq. Ft Cu. Fk �. F�t. C�t �+_t._..00O.00± ___.. To be Completed ..._. _._. Storm da�aa,ge repair Iu aoodderatlam of the iasusnce to me of a permit to constnict the buil ' 'bed abwe, I agree to do tl� p�oQosed w�o�k in acoorciance with the descriptioa abrnve forth in com ce wi all 'one oi a�+dinenoes o� the eity oP Frldley. � In 000atdezatim ot the payment of a fee ot i 10•� , permit is hereby granted to_ Reco Constr. Co. to o�struct the building or addition es described above. Thispe rmit is granted upoa the expresa condttiion that the P�n to whoan it is granted and hiss agents, employees and worinnen, in all wark dane in, around aad upon said building or sny part thereof, shall oonform in all respects to the ordinsncee � F'ridle�►� Minnesota regarding locati�,, construcaao, alteration, mainte�nance, repair ana maving of buu - wlo�� dty ]imits sad this permit may be �ak�d a t any time upan violatioa of a�y of the P�vissons oi� Allea Jensem � � NOTlC� 1W pMnk doa � eowr Nw ew�lro�ik�, intdluis� fer rririN. PbwW�O. ws I�wM�O. srw�r ar wat�r. M sun to sN fw MNd� I��p�eNr fer s�prMr P�e�i1s fer fM� b�ws. __y_z� , , � . � O � �--� A ., . �PPLICATION FOR B�DiNG-PERMIT � CITY OF PRIDI.�Y� �NNl:SOTA _ �.. _ _ --- ---- . Oi�R' S NAI� !J f�"J�.�% �S �� O/��l`�Q-i� BUILDER . N_ L° D�� � S T/� � c�` i O I`[ �nnxE,ss . � _3/ � %�e� �v'� �`��i`3�c e— Ann�ss / �// —.So v f�i �""�'`�/re �7�- . . � jN�p���'l rs y� �;�r{`( � � Loc�z�ox oF at�.niNc No� (P 3�— Street��� /�/ ��L� Part of Lot . Lot_��Biock Additionc or Subd�visien �_.. Coraer Lot Inside Lot ,_,_ $et�'��C Side-Yarsi •:-. ° SEWER E�,EYVATIQN FOUNA�TION EL�V'A`1ZON Applieant attach to thi� form Two Certificates of.Survey of Lo� and proposed �ild-� ing , �:ocation, d�'�wn o� these �el�tificatea . . �� ti' �`�` � A- l�1 A-9 e— %� 6. a..0 %�/� �i 1L --S ` b%�`[ � DESCRIPTION OF BVILDING )Y � S C- Y e P�� R"S 1b be used �s: �'ronC Depth i�eight, ;' 9q. Ft. Cu. Ft. �ront Depth Height �q. Ft. Cu. Ft. Type af Constructioa Estimated �ost �� c�--�-0 � .�- b� _S;aanpl.eted The undersigned hereby makes application for a permit for the.work herein specified, agreein�g to c�o a37. work it� strict accardaace with the City of Pridley Ordinances and rulings �� the Department� of Buildings, and hereby declares that all the f�cts and represe.4ta[ion.s stated in this applicati are true and correct. ' ; d � ��C� o Ca �� S7�/2��� � /', �Sc�ednle of Fee Costs can be found on the Reverse Side). R ` . I�r� � � A M � � M sue�ecr PE O. City of Fridley 217 9 AT THE TOP OF THE TWINS g � I L D{ N G P E R M I T � � � . � � COMMUNITY DEVELOPMENT DIV. Q r �~ � PROTECTIVE INSPEC710N SEC. � Z� Q � � � � � � �"'1 � CITY HA�L FAIOLE� 55432 NUMBEA AEV. OAT£ PAGE OF APPROVEO BY !"""�'� �'� 612-571-3450 910-Ft5 4/19/93 / / JOB ADbRESS 631 Helene Place NE t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 7 Donnays Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZiP PHONE Joy Drawert 631 Helene Place NE 572-2584 3 CONTRACTON MAIL ADDRESS ZIP PHONE LICENSE NO. D& D Hcene ilqpravement I�c. 74Q1 Central Ave NE, Fridley 55432 784--7543 4840 4 ARCHITECT OR DESIGNER MAI� ADOfiESS ZIP PHONE I.iCENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE IICENSENO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION O ALTERATION C� REPAIR ❑ MOVE ❑ NEMOVE 8 DESCRIBE WORK Reroo� Ih�ellinc� & Gaxac�e (=13 SqnarBS�, 2nd Layer 9 CHANGE OF USE FROM TO STiPULATIONS �Q��ng can be the 2nd layer but not th� 3rd. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AU7HORIZED IS NOT COMMENCED WITHIN 60 DAVS, OR tF CONSTRUCTtON OR WORK IS SUSPENOED OH ABANDONED FOR A PERIOD Of 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TPUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX WI H WR ETHER SPECOIF ED EREIN+OR NOTOTHE GRANTING OF AOPERMIT $1(nQ"7 S• SO OOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pEfiMIT FEE SAC CHAFGE PROVISIO F ANY OTHER STATE OR LOCAL LAW REGULATING CON- $27� oo Fire SC �$X $�-.OI STRUCTI N O THE PERFORMA CE OF CONSTRUCTION. P�AN CNECK FEE TOTAL FEE �� License SC $5.00 $33.51 S�GN.4TUFlE OF CON'AACTO:� OA AUTHOA�ZED AGENT ID.4TE1 WHEN PROP Y V �I ATE THIS IS YOUN PERMIT ♦ � `/I -%.� -- S�GNOTUaE OF OwaFq:.�� pwNEP BUiLDER; iDATE� 4. OG �NSP � pbTE NEW [ ] ADDN [ ] ALTER [ j Construction Address: CITY OF FRIDLEY 5INGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit AppliCation � Eitective 3/1I92 �f2oS� Legal Description: Owner Name & Address: ;->a'Ul lP���� Tel. #.S%Z��S� Contractor: D& D Home Improvement, Inc. MN LICENSE # 4840 p��: 7401 Ce�ntral Avenue N.E., Fridley, MN 55432 Tet. # 784-7543 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Le.ngth Width Height GARAGE AREA: Length Width Height DBCK AREA: Length Width Hgt/Ground OTHER: Sq. Ft. Sq. Ft. Sq. Ft. Corner Lot [ J Inside Lot [] Ft. Yd Sexback Side Yard Setbacks Dp Type of Construction: - .�/� - B�ISc° � Estimated Cost: S �1.� �� �' A�rox. Completion Date: �r4c.,,t L�'����� (Cost on Bac�C) Driveway Curb Cut Width Nceded: Ft. + b Ft = Ft x$ _$ DATE: � APPLICANT: �i1s ����+�� Tel. # �1 � . Permit Fee $ %�� Fee Schedule on Reverse Side Fire Surcharge $- %- 0�3 .001 of Permit Valuation (1/lOth%) State Surcharge $ , S 4 � S-/ .50/$1,OOQ Valuation SAG Charge $ $700 per SAC Unit License Surcharge $ 5��� $5.00 (State Licensed Residential Contractors� Driveway Escrow $ Alt. "A" or Alt. "B" Above Pazk Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [] Not Necessacy [] ToTAL STIPULATIONS: �� $ � 335� �= � SuBJECT City of Fridley � � ; `; 9 AT THE TOP OF THE TWINS g � I L D I N G P E R M I T r � �• COMMUNITV OEVEIOPMENT D�V. NECEIPT NO. � �..------ . d0 � � r � � PROTECTIVE INSPECTION SEC. � � � � �"'1 � CITY HALL FRIDIE� 55432 NUMBEA REV D�TE P�GE oF A�VHOVED B� �""�'� ,'' 612-571-3450 910-F15 4/30/97 / � J08 ADDRESS 631 Helene Place NE 1 LEGAL LOT NO. BLOCK TRACT OR AODITION SEE ATTACHED DESCR. 9 7 Donnays Lakeview Manor SHEE7 2 PROPERTV OWNEFi MCCOIIV�112 MAIL AODRESS ZIP PHONE Joyce =�-�? fi31 Helene Place NE 572-2584 3 CONTRACTOR MAIL ADDRESS ZIP PMONE LICENSE NO Same 4 ARCHITECT OR OESIGNER MAIL ADOHESS ZIP PMONE LICENSE NO 5 ENGINEER MAII ADDRESS Z�P PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK O NEW C� ADDITION O ALTERATION ❑ REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Construct a 16' x 10' Deck 9 CHANGEOFUSEfROM TO STIPUTATIONS See notations on plan. 1+�q Be�� d1 ��� all utili�g�ng C��� � Y /o�atians�or RF�v�R 4-� Fp B �, ��W TVPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBtNG. HEATING, VENTILATING OFi AIR COND IONING. THIS PERMiT BECOMES NU�-"A'F(6 GOIO IF WORK OR CONSTRUCTION 20NING SQ. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OF IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO- DWLG. UNITS OFFSTFEET PARKING I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATIQN 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTA% AND ORDINANCES GOVERNING THIS TYPE OF WOqK WIIL BE COMP�IEO $1,419 �.%1 WITH WHE7HER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMiT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- �(EH.SO Fire SC �1.�F2 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECKFEE TOTALFEE $50.63 IGNATUAEOFCON�?ACTOAOAAUTM �ZEDAGEN7 i T i WHEN PiiOPERLY LIDA ED THIS IS YOUR PERMIT f� _ � C cr,r�> Gf/� _ .r�-3� "�% � NAT OFOWNEA��FOWNEFBUiLDERi IDATE� BL �NS� r�4TE � � � i NEW ADDN ALTER [] �] Ll CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Effective 1 / 1/97 ConstructionAddress: (p � � �� �.� y� .� � �a.c � ;U � Legal Description: Owner Name & Address: �J o� C-Z.. �� �n v� l �.2 Tel. #�� � 5�/ Contractor: � (,� Q � MN LICENSE # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IlVIPROVEMENT Tel. # LNING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length (��� Width 1�� r Hgt/Ground Sq. Ft. �LD��-�l OTHER: _ = � `�/`�'� � Construction Type: ��,r,b� ,` �:, ;�� e�� �r e�� � e,� Estimated Cost: $ J (Fee Schedule on Back) Driveway C�.ub Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: .3l� APPLICANT: J � f c� �,C�'1Y1 V � L, l.-L. Tel. # s 70�-'� a`� Permit Fee Fire Surcharge State Sarcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: � �I , � $ , Z $ � � $ $ $ $ $ $ � ��0, G3 CITY USE ONLY Fee Schedule on Reverse Side 001 of Pemut Valuation (1/lOth%) $.50/$1,000 Valuation $950 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] .w 1 � � � � . � �1 � � :.y; .� , � ��.�. r '►� �� � - .q x � N r. c � � -- - � . i °�� � � , �� ��� �-+ ' ' � � .. -� � . . l.o � `.; I � � � � '-� °� i f � : � ` � ; � � � I � �� �! � � } r � � � � � � 1 � I �' \` � � � � � \ V � v� , � I �-. ! � � � � ' � 2 1 �! 2iw� � � � ' � � ' V � �- -- �. i—= �� � j _ f �. � � ------ J . { � ` � ^ . � ty�`- '�. I �' � 9 � � -- - --- -- -- ------- - w , u E . . _ ,t I�{ o! � � �} r y� . \` . � ! � � ,v �; � "1; i U .:, (� _ � ~�j .�a. � I �'/'�; .� ,.^ � 1; � - � �� `_\� �' � i ��: � .� � -- �f � � � �� � � � � . x �. � 3 � �. � �.� "� ��, � �'� �,/� � � , � �� ; � � , � � � � ;� � � +� ` � n � .� �. � � `�-� r� � ���,_ � � � � � �� � � • �� � ' .. ; N � � °��"-.'�' � �I i �� N � ' � -� �C-.� ", � '►° '�� -?xs: ��. �¢J � , _ �� �> ; � ; � „ " `' }� � � . � � � i a , �� � x X `� .W M j � � �� � i � � � N � i , L '; '� i : i; �_-. .� � `,g i � � `A . `\ . � � ' 1.L '. l ,� � � � � � '�" N "' \ � ��� � �� I �`; �1 � ' l � �° �� J h � � � i �, � �� � x z �. � � I� �' U N � ' �' H I u � � � h � � x( N; �-, \, � i �i ,' Y' 7 �� e ,'°�' .�J i • � { �� �: n � Q ` �N ._, � , �r � L� t�!' � �.:,1 -_.., � ,� � � � � '� � i� •` ��� � � � � ,� - r�� �\ � •' l. . I � �i � �` �N� �1 R N , . ��, a al l�, .���s � f '' .. ti • r.i '� .c � � � rY '�_ ,�, �-�--- ----- -----� � j�l �r;;a,� j.�li _�]l�_ .'•.�•."�_i .' • � ' � i.�F,F.,_�=— ='�:y�i ?hF�l:'F':'ri1 � � `_ . sue�ec, P City of Fridley 2 81 18 ;, AT TME�,�_M���4 B U I L D I N� P E R M I T , � �6�/ � `� _____ COMMUNITY OEVELOPMENT OIV. r � � PROTECTIVE INSPECTION SEC. 1 . . i•---� ��"�;'� CITY NA�� FRIOLE� SS�3Z NUYBEp REV OATE PAGE Oi envnov¢o sr � 612-57�-3a50 s�aF�s 10/6/98 / / J08 ADDRE55 631 Helene Place NE t �EGAL ��T NO. BLOCK TRACT OR AODITION SEE ATTACHEO DESCR. (� 7 Donna s Lakeview Manor SHEET 2 PROPERTV OWNER MAIL AOORE55 ZIP PHONE Jo McConville 572-2584 3 CONTRACTOR MAIL ADOFESS ' 21P PMONE IICENSE NO Four Seasons Roofin & Rem. 79 0 Univ. Av - 1 ! ARCMITECT OR DESIGNER MAIL AOORESS ZIP PHONE IICENSE NO 5 ENGINEER MAII ADORESS 21P PMONE IICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW O AODITION O ALTERATION f�x REPAIR O MOVE O REMOVE 9 DESCRIBE WORK Reroof house and ara e(23 S Tear-off 9 CMANGEOFUSEfROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYP� OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD SEPARATE PERMITS ARE REOUIREO fOR ELECTR�CAL, PLUMBING. MEATING, VENTI�A7ING OR AIR CONOITIONING TMIS PERMIT BECOMES NULL ANO VOIO IF WORK Op CONSTRUCTION 20NING SO. fT CU fT AUTHOFIIZEO IS NOT COMMENCED VjIITHIN 60 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENOED OR ABANDONED FOR A PER100 OF 120 pAYS AT ANV TIME AfTEii WOFK IS COMMENCEO. NO DWLG. UNITS OFfSTREET PARKING 1 HEREBY CERTIfV THAT I MAVE READ ANO E7(AMINEO TMIS APP�ICA710N STA��S GARAGES AND KNOW TME SAME TO BE TRUE ANO CORRECT. ALl PROVISIONS OF LAWS VALUATION SURTAI( AND OROINANCES GOVERNING THIS TVPE OF WORK WILL 8E COMPLIEO WiTM WMETMER SPECIF�EO MEREiN OR NOT 7ME GFANTiNG OF A PEAMIT j9]1 .9H DOES NOT PqESUME TO GIVE AUTHORITY 70 VIOLATE OR CAMCEL TME pEqM1T f EE SAC CNARGE PROVIStONS OF ANY OTMER STATE OR LOCAL lAW REGUTATING CON- ST U TI OR THE PEflEOfiMANCE OF CONSTRUCTION (�2,.2rj lre SC �1.9% �— �� �j PLAN GNECK f EE OTA� F "x Licen . 0 70 0 S�Ga�TUQEO CON'F , AOp�UTNOA�ZED�GENi IOATE� pq Eq�r � � ED IS V UR PEqMI U' S�GNa�UQEO�OWHEQ���OWHEQBU40EAi �O�TE� � � BIOG � ���rf . NEW [ ] ADDN ( ] ALTER [ J ConstructionAddress: CITY OF FRIDLEY SINGLE FA1�iILY AI�iD DUPLEXES R-1 A��iD R-2 BUILDING PERMIT APPLICATION 31 Effective 1/1/98 �� 6 p� �� �o � Legal Description: Owner Name & Address: e Tel. #J��� —��� .� _ . . Contractor: Address MN LICENSE #i , Attach to this applicatio�n, a Certificate of Survey of the lot, with the proposed construction drawn on it to scate. DESCRIPTION OF �IPROVEMENT LIVING AREA: Length Width Height _ GARAGE AREA: Length Width Height _ DECK AREA: Length �, Width _ Hgt/Grou OTHER: Tel . # �'J�j -' g`�''/(� T Sq. Ft. Sq. Ft. Sq. Ft. � �3� Construction Type: Estimated Cost: $ �� %/ (Fee Schedule on Back) Driveway Curb Cut Width Needed: DATE: ��� �0 APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Fscrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Ft. + 6 Ft = Ft x$ _$ Tel. # $ (D�-�1� Fee Schedule on Reverse Side $ l 9%.001 of Permit Valuation (1/lOth%) $ �� $.50/$1,000 Valuation $ $1000 per SAC Unit $ , Od $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] $ -ozC� �r 0 0 N d�' Z ; O U ~ � g W W W � � W Q� � � Z � V � Q Q Q U � �� � W _ � �- � � � _ �! 0 Z Q Z � O �"' Z � gz a � � U W � � ¢ O 0 a Z � ¢ oz LLo O ¢ H � W U �? aa,. w Q � �__� ___, _ O �" U W n. Z � ti Z 00 e-I � r'i ti � � m � ti W z � � Q c'�� � � � � LL � tf> O 1.L > z m p 'c � c� � = T ~ � m � M U c`to u � � Z H � � W n. il N � ¢ O U � � � �W � � ¢ ° � :� � ° o m w � � � � � � a�� o °o, o ,;_� M o 0 Ki fA l�9 w J � 0 W x U W Q � � a� C � m s `o � �j U � � U i � Q t�i 'a +-' C � �a � � = U c N f° � U � w c� � j�; L N � �i m t.' 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